精索静脉曲张手术方法的探讨

为探讨精索静脉曲张的手术治疗方法，对１２例精索静脉曲张患者，采用耻骨联合上方一个横切口进行双侧精索静脉探查，结果发现临床诊断单侧精索静脉曲张者均伴有对侧精索静脉曲张，即行双侧精索内静脉高位结扎术，随访０．５年以上，精索静脉曲张消失。并就目前外科治疗精索静脉曲张的手术方法进行了讨论。认为对精索静脉曲张者最好用一个手术切口常规探查对侧，发现精索静脉曲张明显，均应作双侧精索内静脉高位结扎，这样对恢复患者     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张85例报告

目的:探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的有效性、安全性及价值。方法:回顾分析我院为85例患者行腹腔镜精索静脉高位结扎术的临床资料。结果:85例手术均获成功,平均手术时间32min,基本无出血,术后平均住院3d。随访3～10个月,3例复发,复发率3.5%。结论:腹腔镜下精索静脉高位结扎术治疗精索静脉曲张具有创伤小、康复快、效果好、并发症少等优点,对双侧精索静脉曲张及开放手术后复发的患者尤有临床价值。     

显微外科手术治疗再发性精索静脉曲张——附30例报告

目的 :采用显微外科手术治疗再发性精索静脉曲张症。　方法和结果 :对 30例再发性精索静脉曲张病人用 4倍手术放大镜手术 ,30例均成功 ,未见再次复发。　结论 :对传统各种手术进行讨论 ,并提出应采用显微外科手术治疗传统手术后再发性精索静脉曲张症 ,效果良好。     

腹腔镜下保留精索内动脉的精索静脉高位结扎术700例总结报告

目的评价腹腔镜保留精索内动脉的精索静脉高位结扎术的效果及价值。方法回顾分析自2007年1月至2014年1月在我科室应用钛夹、超声刀、丝线结扎等不同方式行腹腔镜下保留精索内动脉的精索静脉高位结扎术患者700例的临床资料,探讨腹腔镜下保留精索内动脉的精索静脉高位结扎术的安全性及有效性,并对治疗效果、并发症及手术经验等进行总结分析。结果 700例精索静脉曲张患者,年龄16~46岁(平均27岁);其中单侧精索静脉曲张患者482例,双侧精索静脉曲张患者218例,均采用腹腔镜行双侧精索静脉高位结扎术,术中均分离并保留双侧精索内动脉。其中钛夹组患者150例,超声刀组患者200例,丝线结扎组患者350例。手术时间30分钟~60分钟,平均手术时间43分钟;住院时间3~5天。术后患者均取得较满意治疗效果,阴囊坠胀不适感明显改善,不育患者复查精液显示精子质量较术前明显提高。术中出现皮下气肿患者18例,术后出现睾丸鞘膜积液者12例,睾丸炎者8例,术后复发者5例,均经保守治疗或二次手术后治愈。无输精管损伤、睾丸萎缩病例发生。结论腹腔镜保留精索内动脉的精索静脉高位结扎术能更大限度保留睾丸血供,具有简便、微创、并发症少、效果可靠、术后恢复快等的优点,尤其适用于双侧精索静脉曲张、具有腹股沟区手术史、术后复发等患者,是治疗精索静脉曲张的有价值的方法,可作为手术治疗的首选方式。     

腹腔镜手术治疗精索静脉曲张26例报告

目的:探讨腹腔镜手术治疗精索静脉曲张的可行性。方法:对26例精索静脉曲张患者的临床资料进行回顾性总结分析。结果:手术均获成功,平均手术时间34m in,平均住院3d,症状均改善或消失。结论:腹腔镜下精索静脉高位结扎术治疗精索静脉曲张是一种安全有效的方法。     

电视腹腔镜下精索静脉高位结扎术

目的 :探讨电视腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的临床经验。　方法 :利用电视腹腔镜技术 ,经腹腔径路行精索静脉高位分离、结扎术。　结果 :34例病人手术后均取得满意的临床疗效。　结论 :精索静脉曲张是电视腹腔镜手术的最佳适应症之一。     

腹腔镜治疗精索静脉曲张118例临床研究

目的:总结腹腔镜治疗精索静脉曲张经验和教训。方法:回顾分析118例腹腔镜下精索静脉高位结扎术的疗效和康复情况。结果:118例手术均获成功,平均手术时间38 min,出现并发症2例,2例术后阴囊气肿。术后平均住院3天,随访3～12个月无复发。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,尤其适用于双侧精索静脉曲张、开放性手术后复发或有腹股沟手术史的患者。     

腹腔镜和开放手术治疗精索静脉曲张的效果分析

目的对腹腔镜和开放手术治疗精索静脉曲张的临床效果进行对比性分析。方法选择笔者所在医院收治的90例精索静脉曲张患者,随机分为治疗组和对照组,治疗组患者应用腹腔镜手术,对照组患者应用开放手术,比较两组患者的手术治疗效果。结果两组患者在出血量、手术时间、术后体温、住院时间等方面存在的差异具有统计学意义。结论治疗精索静脉曲张,腹腔镜手术是一种有效、安全的方式,患者在术后康复较快,值得在临床广泛应用。     

重度精索静脉曲张治疗体会

精索静脉曲张系指因精索静脉的血流淤积而导致精索的蔓状静脉丛扩张、伸长、迂曲改变。其中症状明显或已引起睾丸萎缩、精液质量下降及造成不育者需要手术治疗，现治疗多以精索内静脉高位结扎术和腹腔镜手术为主，但重度精索静脉曲张症状明显者因阴囊内曲张静脉团未消除，故术后症状常不能消失。1999年8月～2006年8月本院对85例重度精索静脉曲张患者进行了临床研究，现报告如下。     

腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效观察

目的观察腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效。方法 回顾性分析对精索静脉曲张45例患者采用腹腔镜下精索静脉高位结扎术治疗的临床资料。结果本组患者均顺利完成手术,手术时间30～60 min,平均40 min。术后左阴囊气肿2例,反应性睾丸鞘膜积液1例,阴囊坠胀不适感2例,均未做任何处理,2 d内自行消退。所有患者精索静脉曲张症状均消失或明显改善,无复发和睾丸萎缩。结论腹腔镜精索静脉高位结扎术治疗精索静脉曲张创伤小、复发率低,必将彻底代替传统的开放性手术。     

Frontal resection as a means of decision for surgical treatment of rectum cancer

The work has been devoted to the improvement of methods of surgical treatment of cancer of the rectum. The possibilities to perform organ-saving operations in treatment of cancer of the rectum are discussed. An analysis of treatment of 351 patients with cancer of the rectum has shown that frontal resection of the rectum is possible in more than 40% of such patients since such interventions save the function of the rectum more completely. New methods of preoperative preparation of the patients are described as well as the application of the improved methods of surgical interventions.     

不同营养评价方法对消化系恶性肿瘤病人营养状况评价的意义

目的:了解消化系统恶性肿瘤病人术前的营养状况,比较不同营养评价方法在评价结果上的差异。方法:分别应用传统的单项营养评价指标、主观全面营养评价法(SGA)和欧洲营养风险筛查-2002(NRS-2002)评价瑞金医院普外科消化系统恶性肿瘤病人术前的营养状况,并分析各营养评价方法及所产生结果间的相关性。结果:不同营养评价方法得出病人营养不良的发生率不同(8.98%～62.68%),其中SGA与NRS-2002的评价结果间及其与传统的单项评价指标的评价结果间都有显著相关性(P0.01);在传统的单项营养评价指标中,仅同类评价指标的评价结果间相关性较好。结论:相比传统的单项营养评价指标,综合性营养评价方法SGA和NRS-2002的结果更为全面、准确,然而仍存在一定的局限性,有待进一步改进。     

Clinical aspects, diagnosis and treatment of cranio-thoracic injuries in patients of different age

The comparative analysis of the clinical manifestations and informative value of the adjuvant methods of investigation in 125 patients with ++cranio-thoracic injuries and 53 patients with isolated craniocerebral trauma was carried out. This permitted to define more precisely the possibilities of the methods of neurosurgical diagnosis and find the optimal methods for the treatment of patients of different age with ++cranio-thoracic injuries.     

Alternative und additive Therapieverfahren bei interstitieller Zystitis

Alternative therapies are gaining more and more popularity. Mostly, these methods are demanded by patients who are not effectively relieved by allopathy. This review points out alternative and additive methods that have been repeatedly described as effective as additional supportive treatments of interstitial cystitis.     

围术期微创监测心输出量方法的进展和临床评价

背景围术期心输出量(cardiac output,CO)监测是反映心脏功能的重要参数之一。近年来随着计算机软件的发展,微创监测CO的方法越来越受到关注。 目的将围术期微创CO监测方法的新进展进行综述,客观评价其在围术期血流动力学监测的作用。内容概述微创CO监测方法FloTrac/Vigileo系统监测CO、脉波指示剂...     

Cholescintiscan or infusion cholecystography in acute cholecystitis. A prospective study

Two methods of diagnosing acute cholecystitis--cholescintigraphy and infusion cholecystography--were compared in a prospective study of 105 patients. Sensitivity and specificity were very high (96-99% and 91%, respectively), without difference between the two methods. Infusion cholecystography gave transient rise in liver enzyme levels in more than half of the patients. Cholescintigraphy gave no side effects. Cholescintiscan could be performed at moderately elevated bilirubin levels. It also gave information concerning liver malignancy in four patients. On these grounds, cholescintigraphy is the preferable of the two methods.     

Contrast methods of study in the diagnosis and treatment of hernias of the lumbar disks

Under examination and treatment there were 154 patients with lumbar osteochondrosis. In diagnosing the diseases contrast methods were used: pneumomyelography in 70 patients, peridurography in 114 patients, discography in 30 patients. Surgical treatment was used in 105 patients. An analysis has shown the contrast methods of x-ray examination in hernias of lumbar disks to establish more exact levels of localization of the process which facilitates determination of a rational operative access. Discography was shown to be the most valuable and reliable method of diagnosis of the disease.     

持续半年以上胰外瘘的非手术治疗

目的：探讨持续半年以上的胰外瘘的非手术治疗的疗效。方法：总结8例持续半年以上胰外瘘患者的发病原因，胰液引流量的大小，合并邻近器官的损害情况，非手术治疗的措施以及愈合时间等因素，结果：8例胰外瘘半年以上患者经非手术治疗全部治愈。结论：对某些持续半年以上的长期胰外瘘，通过应用综合性非手术治疗可以使其闭合，不一定要采取手术治疗，从而为长期胰外兼的患者在治疗上提供了多一种选择。     

Prognostic indices for survival during postcardiotomy intra-aortic balloon pumping. Methods of scoring and classification, with implications for left ventricular assist device utilization.

To define more clearly a salvageable patient for possible utilization of a left ventricular assist device prior to multiple organ failure and irretrievability during postcardiotomy intra-aortic balloon pumping (IABP), we made prospective and retrospective analyses to determine prognostic indices for survival. Serial left ventricular function curves (IABP on-off), scoring methods, hemodynamic and renal function tracking trajectories, survival versus nonsurvival data envelopes, and classification methods were developed and used. All patients requiring postcardiotomy IABP support who were in Class A survived; 80 percent of the patients in Class B survived. All patients who remained in Class C for 12 hours or more following operation with IABP support died. These preliminary analyses suggest that the postcardiotomy IABP-supported patient with a score of less than 6 who remains in Class C for 12 hours or more is at the highest possible risk and is a probably candidate for more effective support with a left ventricular assist device.     

Plasmapheresis in combined treatment of patients with acute intestinal obstruction

Comparative analysis of the results of treatment of patients with acute intestinal obstruction was carried out. Plasmapheresis was used in postoperative period in 38 patients. 32 operated patients were treated with conventional methods of detoxication. It was established that after the earliest performance of plasmapheresis in postoperative period, manifestations of toxemia revived more rapidly and significantly and intestinal motility restored more rapidly.